Provider Demographics
NPI:1164821310
Name:MONTOYA, CRYSTAL LAURA JANE (DPT)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:LAURA JANE
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CENTRAL AVE SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3656
Mailing Address - Country:US
Mailing Address - Phone:505-242-2294
Mailing Address - Fax:505-242-2917
Practice Address - Street 1:600 CENTRAL AVE SE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3656
Practice Address - Country:US
Practice Address - Phone:505-242-2294
Practice Address - Fax:505-242-2917
Is Sole Proprietor?:No
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist